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The Human Resources for Health Crisis in Zambia

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the expectation that they would be absorbed by the public service. This process has since changed, and recruitment can now occur only for already funded positions, the number of which being often below the announced number of vacancy establishments. Indeed, in 2008 close to 40 percent of the established posts were not funded (table 2.9; Vujicic and others 2009). Automatic absorption of graduates into the private health labor market moreover is not expected (although is a possibility) given the relatively small and underdeveloped private sector (See discussion on profit and not-for-profit private sector below). Table 2.9. A significant percentage of desired posts are not funded in Zambia Established posts (2006–2008)

Funded posts (2008)

Percentage of established posts not funded (2008)

51,000

30,883 (26,523 in 2007)

38.234

Source: Adapted from Vujicic and others (2009).

Interestingly, what seems to be a misconception is that a recruitment ban under structural adjustment negatively affected labor market entry. The study by Vujicic and others did find that the decline in the number of health workers on the MoH payroll between 2003 and 2006 was due largely to the wage-and-hiring ceiling set by international financial institutions in response to excessive public spending. But the same study however also found that the recruitment ban however complemented decentralization efforts under which district health management teams (DHMTs) and hospital management teams were responsible for recruiting health workers using other funding to pay for salaries, such as basket funds and user fees. Hence, although the number of health workers on MoH payroll declined, numbers of recruitments simultaneously increased funded by alternative sources. Indeed, when more health workers were put on the government payroll in 2006, after a partial lifting of the recruitment ban, most of the added staff had already been recruited and deployed by the DHMTs and hospital management teams (using alternative funding) to address shortages existing prior to 2006. Consequently, the recruitment ban may have affected the tenure of national health labor market workers from 2003 to 2006 (for example, until the ban was lifted, staff members recruited during that period were put on limited duration contracts rather than on the regular payroll [CHESSORE and Wemos 2008]). Still, no evidence exists that this ceiling limited labor market demand or that it increased unemployment among health workers or affected service delivery. High labor market exit

There are indications that exit out of the national public health labor market primarily of doctors may also be considerable. Although data in Zambia exist only on the number of health workers exiting the public health labor market, limited opportunities in the private health sector (see discussion on size of for-profit and not-for-profit private sector below) means public sector a rition likely reflects a rition out of the health labor market altogether (rather than public to private transfer). A rition among public sector health personnel has increased in recent years, particularly among doctors and nurses, at a rate of 5.4 percent. Doctors have an a rition rate of 9.8 percent, nurses have a rate of 5.3 percent, and pharmacists, 4.6 percent (table 2.10; Kombe and others 2005).

The Human Resources for Health Crisis in Zambia  

Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the he...

The Human Resources for Health Crisis in Zambia  

Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the he...